Provider Demographics
NPI:1598976805
Name:SILVERMAN, KENNETH (LAC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:YITZCHAK
Other - Middle Name:
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1328 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:718-686-1910
Mailing Address - Fax:
Practice Address - Street 1:4315 14TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-686-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1310171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist